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Short-term versus continuous antimicrobial therapy for asymptomatic bacteriuria in pregnancy.

Asymptomatic bacteriuria was identified in 300 pregnant women prior to the 28th week of gestation. In one group of 200 women short-term treatment with either nitrofurantoin or sulfamethizole was given for 14 days, and in another group of 100 women continuous therapy with one of these drugs was given for the remainder of gestation. Weekly urine cultures were obtained from all the women. Of the women treated with short-term therapy, 65% were abacteriuric for the remainder of pregnancy following one course of therapy, 24% became abacteriuric but subsequently relapsed, 2% had reinfection after becoming abacteriuric, and 9% demonstrated no response. Following treatment with a second course of short-term therapy, another 19% of these women were cured for the remainder of their pregnancy, and 3.5% responded to a third course. In the continuous therapy group, 88% of the women became abacteriuric for the remainder of the gestation, 3% demonstrated relapse, 2% developed reinfection, and 7% had no response to the first drug given. These data demonstrate that short-term administration of antimicrobials, when combined with surveillance for recurrent bacteriuria, is effective for the management of the pregnant woman with asymptomatic bacteriuria.

Bacteriuria

Asymptomatic bacteriuria in adolescent girls: I. Epidemiology.

Because the incidence of bacteriuria in asymptomatic school girls is low (1% to 2%), we examined possible risk factors in adolescents, such as previous history of urinary tract infection (UTI) and sexual intercourse (previous and recent). Eight (1.6%) of 500 adolescent girls were detected with asymptomatic bacteriuria (ABU). Of 47 patients reporting a previous UTI, four (9%) were bacteriuric. Two other patients detected with bacteriuria had a history of enuresis; thus 6/8 adolescents with ABU had a history that suggests a need to screen for infection. A history of sexual activity was not helpful in case detection. Of the 500 girls, 133 had a routine pelvic examination at the time of the visit. The procedure was not associated with bacteriuria, as measured by a home nitrite test each day for three days following the clinic visit.

Adolescent

Bacteria causing symptomatic urinary tract infection or asymptomatic bacteriuria.

One thousand bacterial isolates from consecutive suprapublic aspirations of urine in two groups of patients with symptomatic urinary tract infection and two groups with asymptomatic bacteriuria were studied. Staphylococci accounted for 13 and 27% of the isolates from symptomatic patients but for only 3 and 4% of strains from asymptomatic bacteriuria. Conversely, 18 and 30% of Escherichia coli isolates from asymptomatic bacteriuria were auto-agglutinable when tested with antisera to the common urinary O-serogroups, whereas such strains accounted for only 5 and 7% of the E. coli from symptomatic patients. The high prevalence of auto-agglutinable E. coli in asymptomatic bacteriuria was accompanied by a reduction in the frequency of the common uninary O-serogroups rather than other smooth strains.

Adolescent

Asymptomatic bacteriuria in schoolgirls. VIII. Clinical course during a 3-year follow-up.

A 3-year follow-up of 116 schoolgirls with asymptomatic bacteriuria, treated or untreated is reported. It is concluded that bacteria isolated from girls with asymptomatic bacteriuria do not commonly cause symptomatic pyelonephritis and that the risk of developing renal damage as a result of asymptomatic bacteriuria in a schoolgirl with a roentgenographically normal urinary tract seems to be small. It is also suggested that for the majority of these patients therapy is not necessary.

Adolescent

Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation.

Asymptomatic bacteriuria (greater than 100,000 microorganisms per milliliter) was found in 70 of 1,400 pregnant women without symptoms referable to the urinary tract (five per cent). With the fluorescent antibody (FA) tests, antibody-coated bacteria were demonstrated in specimens from 35 patients (50 per cent), indicating silent renal bacteriuria. Although confirmation by direct localization methods was not feasible in this group of patients, indirect evidence of renal function impairment associated with the presence of antibody-coated bacteria was suggested by results of the serum creatinine and creatinine clearance tests. The outcome of the pregnancy was compared for patients with bacteriuria (FA-negative or FA-positive tests). An association between the presence of asymptomatic renal bacteriuria and intrauterine growth retardation was noted. Thus, the patient with asymptomatic bacteriuria and a positive FA test is at greater risk of delivering an intrauterine growth-retarded infant.

Bacteriuria

Asymptomatic bacteriuria in schoolchildren in Newcastle upon Tyne.

A screening survey for asymptomatic bacteriuria (ASB) in 13464 schoolgirls aged 4 to 18 years in Newcastle upon Tyne showed an overall prevalence of 1.9%. In girls 4 to 6 years it was 1.4%, in girls aged 7 to 11 years it was 2.5%, in girls aged 12 to 18 years it was 1.6%, a statistically significant rise and fall. Renal scarring was found in 39 (15%) of 254 girls with ASB. Neither the prevalence nor the severity of renal scarring increased with age. There was no association between ASB and social class. Of the 254 girls with ASB, 24% had no symptoms. Infections with klebsiella were more frequently associated with renal scarring than infections with Esch. coli. The prevalence of ASB in 1595 boys aged 5 to 18 was low, 0.2%. Ureteric reflux was present in 15% of girls without renal scarring and in 46% of those with renal scarring (P less than 0.001). Renal scarring also showed a significant association with duplication, hydroureter, or single saccules in the bladder. The greater the severity of scarring the more frequently was reflux present. This study gave no evidence that asymptomatic bacteriuria leads to progressive renal damage during childhood. It therefore does not support the recommendation for prescriptive screening of schoolchildren, but emphasizes the need for prospective studies of the natural history of ASB.

Adolescent

Antibody-coated bacteria in the urine of preschool and school-aged girls with asymptomatic bacteriuria.

Urine samples from 3564 girls aged 2 to 13 years were screened for evidence of infection. Cultures were positive (bacteria count, more than 10(5)/ml) in 61 (1.7%) by the dipslide method and in 55 (1.5%) by standard culture techniques. In 13 (23.6%) of the 55, antibody-coated bacteria (ACB) were detected in the urine. The clinical, bacteriologic, radiologic and urinalysis findings in children with ACB were no different from those in children in whom the bacteria were not coated. Direct examination of uncentrifuged urine under high power revealed one or more bacteria per two high-power fields in 96% of infected urine samples and in only 7% of noninfected samples. Five or more leukocytes per high-power field in centrifuged urine were detected in 36.7% of infected urine samples but not in noninfected samples. The ACB test did not differentiate between asymptomatic bacteriuria with parenchymal scarring or vesicoureteral reflux or both and asymptomatic bacteriuria without these abnormalities.

Adolescent

Cost-effectiveness of two methods of screening for asymptomatic bacteriuria.

A comparison of two methods of screening schoolgirls for asymptomatic specimens of urine from 96.3, but that the home self-administered use of dipslides was successful in only 70.2%. The failure to obtain the return of satisfactory dipslides was most frequent in children under seven and over 11 years of age, and in children from the lower social classes; satisfactory dipslides were returned by 84% of children from social classes I, II, and III non-manual workers, but by only 58% of children from social class V and the unemployed. The cost per child screened was pounds 0.77 with the supervised method and pounds 0.26 with the dipslide method. An alternative supervised method which would have successfully screened 85% would have cost pound 0.55 per child screened. Using the home dipslide method, the cost per case of asymptomatic bacteriuria detected would vary from pounds 10.40 to pounds 20.00, depending on the age group screened.

Adolescent

Adhesiveness to urinary tract epithelial cells of fecal and urinary Escherichia coli isolates from patients with symptomatic urinary tract infections or asymptomatic bacteriuria of varying duration.

Adhesiveness to human urinary tract epithelial cells was high for Escherichia coli strains isolated from patients with acute pyelonephritis and acute cystitis, and low for asymptomatic bacteriuria strains detected at screening. Escherichia coli bacteria causing asymptomatic reinfections, detected near the onset of bacteriuria, adhered more than those detected at screening. No difference in the adhesive ability was found between fecal isolates of the strain causing urinary tract infection, isolated at or before onset of bacteriuria, and the urinary strain in symptomatic or asymptomatic patients. Normal fecal Escherichia coli from non-bacteriuric patients adhered less than all other strains tested.

Adhesiveness

Interaction of human serum and neutrophils with Escherichia coli strains: differences between strains isolated from urine of patients with pyelonephritis or asymptomatic bacteriuria.

Strains of Escherichia coli isolated from the urine of children with pyelonephritis (n = 18) or asymptomatic bacteriuria (ABU) (n = 20) were serotyped and compared with respect to opsonic requirements, sensitivity to serum, amount of chemiluminescence produced by normal neutrophils during phagocytosis of the various strains, and amount of capsular antigen. Strains isolated from cases of ABU more often had the capacity to activate the alternative complement pathway than had strains causing pyelonephritis. The ABU strains were also better opsonized in fresh human serum and were more often serum sensitive than the pyelonephritic strains. There were individual variations in neutrophil chemiluminescence during phagocytosis of the various strains, but the two groups of strains did not differ significantly. The strains from pyelonephritis cases produced a greater amount of capsular antigens than the ABU strains. There was no correlation between presence of a particular O or K antigen and capacity to activate the alternative complement pathway. The observed differences between strains isolated from patients with ABU and those isolated from patients with pyelonephritis may be relevant for further studies on differences in bacterial virulence or host defense factors.

Antigens, Bacterial

Reliability of a single urine culture in establishing diagnosis of asymptomatic bacteriuria in adult males.

Fifty-nine asymptomatic men without catheters of ileal-loop bladders, who were attending a urology clinic and were incidentally discovered to have 100,000 or more Enterobacteriaceae per ml ("significant bacteriuria") in a clean voided urine sample, were prospectively evaluated. To identify these 59 patients, 5,876 urine samples, collected exclusively from men, had been subjected to quantitation and identification. A repeat urine culture performed on these patients invariably confirmed the results of the initial culture. The reproducibility of a single urine culture containing significant bacteriuria occurred independently of the tissue source of infection, as determined by the antibody-coated-bacteria immunofluorescence test. We conclude that a single urine culture obtained from a cooperative man can establish the diagnosis of asymptomatic bacteriuria.

Adult

Asymptomatic bacteriuria in schoolgirls. VI. The correlation between urinary and faecal Escherichia coli. Relation to the duration of the bacteriuria and the sampling technique.

The occurrence of the urinary strain in the anus, rectum and faeces was investigated in 27 girls with asymptomatic bacteriuria (ABU). In patients with bacteriuria of relatively short duration 46% of the faecal isolates were of the urinary strain as compared to only 18% in patients with bacteriuria of relatively long duration. In general the correlation between the urinary and faecal flora is striking at the time of establishment of ABU but diminishes with time. The diminished correlation may be due to two factors: firstly, the composition of the faecal flora changes with time. Secondly, the correlation may be obscured by complex changes in the properties of bacterial strains established in the urinary tract. Contamination by the infected urine did not seem to be a serious problem when the rectal mucosa was swabbed proximal to the anal canal.

Anal Canal

Asymptomatic bacteriuria in adolescent girls: II. Screening methods.

Of 500 asymptomatic adolescent girls who were screened for bacteriuria by three methods-dipslide (Uricult), dipstrip (Microstix-3 reagent strips), and home nitrite test (Microstix-Nitrite reagent strips)-eight cases (1.6%) were detected: 6/8 by dipslide and dipstrip; 5/8 by nitrite testing. The false-positive-rate (greater than 10(4) colonies/ml) of the dipslide test was 6.4%, and the dipstrip test, 2.8%. A history of vaginal discharge was not associated with "contaminated" specimens. False-positive nitrite tests were reported by 0.6% of the patients who returned the postcards. Overall, 70.4% of the patients returned the postcards for the home nitrite test. The patients were divided by method of payment (Medicaid vs non-Medicaid) in order to provide an approximation of socioeconomic status; non-Medicaid patients were significantly more likely to return postcards than Medicaid patients (75.8% vs 63.7%). Of the group reporting previous urinary tract infection, 79% of both Medicaid and non-Medicaid patients returned postcards, suggesting that a prior experience with the diagnosis increased compliance with a home test.

Adolescent

The presence of antibody-coated anaerobic bacteria in asymptomatic bacteriuria during pregnancy.

Quantitative anaerobic culture of urine samples obtained from 593 pregnant women by suprapubic bladder aspiration was performed to establish the involvement of anaerobic bacteria in asymptomatic urinary tract infections. The fluorescent antibody (FA) test was applied to the sediments of bladder aspirates to determine the site of infection. Anaerobic bacteriuria (greater than or equal to 10(4) microorganisms/ml of urine) was found in 34 patients, of whom five were FA-positive. These anaerobes were identified as Lactobacillus minutus, Veillonella parvula (two patients). Clostridium putrefaciens, and Peptostreptococcus anaerobius. Aerobic bacteriuria (greater than 10(4) microorganisms/ml of urine) was detected in 27 patients, of whom 13 were FA-positive. In 10 women with mixed aerobic/anaerobic bacteriuria, no FA-positive bacteria were found. The finding of FA-positive anaerobes may indicate that these organisms are involved in silent renal infection.

Adolescent